Nursing: Long hours, risk of assault and injury, but plenty of jobs. Which states are best?

It’s National Nurses Week, and I can’t think of any profession more than nursing that has had more of a positive impact on my life during the past three years.

No matter what was happening with dad in the various settings he lived in during the final three years of his life, I could always count on the nurse on duty (well, at least three-quarters of the time) to address his needs — and mine, too. Whether dad was complaining of pain, sitting in a dirty diaper, or maybe I was just in tears over him being mute on a particular day, nurses played everything from comfort provider to family therapist in an effort to smooth things over.

In long-term care facilities, the nurse on duty supervises the certified nursing assistants (CNAs) who provide most of the daily, hands-on care to your loved one. The good ones earn the respect of their CNAs and run a tight, efficient ship.

But it’s really, really tough work given what CNAs are paid (not to mention that their jobs are possibly even more physically demanding and often thankless than a nurse’s). But you get what you pay for in some places.

There is a huge demand for nurses right now with 11,000 Baby Boomers per day turning 65. Nurses are usually very well paid. But the job is not an easy one. Many hospitals still manage nurses in a militaristic, authoritarian style that keeps good applicants away. Some states have such crippled public healthcare systems and poor working conditions in healthcare facilities that nurses don’t want to work in them.

So where are the best and worst states for recent nursing grads to land those awesome first jobs?

WalletHub has a brand new report written by John Kiernan that ranks every state and the District of Columbia from first to 51st. D.C. is at the very bottom; Washington state is tops.

I’m thrilled to report that both states that encompass my community – the Quad-Cities of Illinois and Iowa –are in the top five.

The top 10 best states for nurses, from the top, are: Washington state, Illinois, Texas, Oregon, Iowa, California, Minnesota, Connecticut, New Hampshire, and Pennsylvania.

And the worst states, in descending order, are: New Jersey, North Carolina, Georgia, Kentucky, New York, South Carolina, Alabama, Hawaii, Louisiana, and the District of Columbia.

Projected Competition: Full Weight (~7.37 Points)
Note: This metric measures the projected number of nurses per 1,000 Residents by year 2022.

Mandatory Overtime Restrictions: Full Weight (~7.50 Points)

Without a bachelor’s degree, expect lower pay, long-term care work

Kiernan talked to several experts about the biggest issues facing nurses today. A big one is that those who do not have a bachelor’s degree increasingly are shifting from hospitals, which pay better, to long-term care facilities.

Another, which may be no surprise to nurses but probably is alarming to most lay people, is workplace violence, lack of resources (both equipment and staffing) and required overtime. It adds up to short tempers and compromises patient care (and I’ve seen it firsthand, unfortunately).

“All of these issues compromise the safety and well-being of both the nurse and the patients,” said Deborah A. Raines, professor of nursing at University of Buffalo. “They also result in nurses leaving positions and at times leaving the profession.”

Karen Cotter, PhD, RN and professor of nursing at Oklahoma Baptist University, told Kiernan, “There are also issues of workplace violence which are well documented, with hospitals being high on the list of places that assault and battery are likely to occur. This is attributed to the stress of the patient/family dealing with an illness, and the nurses dealing with workloads that are at times, unreasonable. Compounding the shortage is that new nurses entering the profession frequently do not receive adequate support and will leave the practice of nursing within the first 12 months after completing their licensure.”

As part of National Nurses Week this week, the American Nurses Association has called for “a culture of safety in all healthcare settings.”

According to a news release, registered nurses rank sixth among all occupations for musculoskeletal injuries resulting in missed work days. Many sustain injuries due to lifting patients – an estimated 3,600 pounds her shift, in fact. “Injuries to nurses and other health care professionals should not be tolerated as just ‘part of the job,” said ANA President Pamela F. Cipriano, Ph.D., RN, NEA-BC, FAAN.

“In a culture of safety, nurses are encouraged to talk openly about safety issues and their impact on patient care,” Cipriano added. “A 2013 study showed that preventable adverse events accounted for 210,000 to 440,000 deaths of hospital patients every year.”

Shocking.

Nurses have a right to be angry, but do unions really help?

Most nurses are a lot like myself. For better or for worse, they are anything but quiet about the shortcomings they see in healthcare, particularly in their working environments. But as I’m learning myself, keeping a positive attitude (or at least trying to) can do wonders for yourself and everyone around you. Of course it doesn’t mean you should just roll over and accept what needs to be changed.

For this reason, many nurses have become extremely involved in their unions. But are these unions really beneficial to nurses?

“Yes and no,” said Jagdish Khubchandani, associate professor of Community Health Education at Ball State University.

“Hospital managements have to look at profits,” Khubchandani said. “Therefore, for them, every employee can sometimes be just a number. Practices such as employee layoffs, fewer salary raises, and increasing workloads for employees are used by hospital managements to make profits. If there are unions, nurses can certainly advocate for themselves and demand salary raises and better social protection in their jobs.

“The bad side is that most unions will not be or are not effective. Most of the times, hospital and healthcare facility management will do as they prefer. In addition, unions need heavy dues and fees, which may not be well appreciated by nurses. Finally, the moral argument may go against nurses if they demand something by forming unions – aren’t nurses supposed to help? Care? Serve? Why would they make a union for example, for greater rewards?”

Ouch. Sounds to me that in an environment where nurses are getting hurt and patients are dying in hospital cultures of overwork, if unions are not necessary than more stringent state and federal oversight may be.

What are your thoughts on the state of nursing care in America? Are you a nurse? Consumer? We’d love for you to share your thoughts with Caregiver Relief.

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